HI All,
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Would love some help regarding a patient who I am having difficulty with currently.
41 YR Old man
History of anxiety and depression
Low Social economic
Low limb Blood flow and nerve conduction WNL
Referral from GP saying "painful corn Right 1st"
Presents with approx 6 month history of painful lesion on Right 1st medial MTPJ.
Worsened to point of appointment him unable to wear shoes or touch the lesion.
Lesion was very vascular with peri- wound tissue very firm. Pain on medial lateral compression and direct compression. More so on direct
1st consult offload with with Semi compressed felt and PPT and ordered US to rule out foreign body and see how it responded to offloading. Couldn't touch it as too painful.
2nd appointment- Ultrasound results discussed, offloading not successful. LA gel used and lesion lanced with purulent discharge. Painful but patient managed
3rd appointment- symptoms were reduced for 3-4 days. Returned to similar levels pre lancing of lesion. LA gel used again and lesion lanced and very superficial curretted. Patient didn't want LA injected. Upon very superficial curettage I noticed lesion had break in skin striations but wasn't typical wart tissue.
Reviewed patient 4 days post lesion currette and it is still bubbling away not as sore as previously but now has a whitey kind of scab overlying.
2 other podiatrists in house have looked at the lesion and we're all stumped. My best guess is a ganglion with underlying bursitis, gouty trophy.
US results and pic of lesion attached at first consult. Will get another pic upon review later this week.
Cheers
Joe
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